TL;DR I am stepping away from psychiatric care for the time being over a breakdown of trust - most of which is not due to my current provider as far as I can tell. I am generally not comfortable with "ghosting" people, but I'm not sure if it is purposeful to provide an explanation in this case.

Do I:

• just "ghost" until I need a refill (2-4 months from now, depending on how I am doing), and at that time just reach out to the front desk and ask them to have the psychiatrist transfer Rx to my GP?
  
• Do I write a letter at this time to make the requested change, and if so, do I write an explanation as to why - my psychiatrist probably already has a general idea, although not specifics, as to why I would be making this decision
• Do I make an in-person appointment and provide the explanation/make the request? My only concern with this is that I would be taking a slot from someone who actually \wants* treatment, and that feels wrong to me.*

Long Version:

I've had a lot of distrust for psychiatrists for years due to a poor provider experience when I was a young adult. I returned to psychiatric care, and have been fairly loyal to the whole system for the last decade, although I admit that there was still a lot of distrust that permeated my interactions and treatment choices.

My current psychiatrist has been 98% amazing over the last 7 years, with one hiccup when involuntary treatment (not involuntary hospitalization - they are separate where I live) was threatened, although I know now that it had been suggested by a colleague so it might not have been completely my psychiatrist's idea. He has been working with me for a long time around building trust, and that basically my skepticism is being fueled by my paranoia as it relates to my mental illness. It should be noted that this is generally the only place where I am "paranoid". However, I was pretty much completely in agreement with him for the last couple of years.

Unfortunately, I had an extremely negative experience with 2 interim providers last year. In trying to correct the outcomes of these interactions, I had to request my health records, which led to a rabbit hole of requesting nearly all of my health records for nearly two decades. In doing so, my supposed "paranoia" was actually completely and fully validated, beyond what I had even suspected.

I recognize that errors in health records are rampant given time constraints, patient caseloads, contexts like emergency room visits, etc. I expect there to be basic errors throughout, and there were. These don't concern me.

However, there were significant and relevant errors that could potentially (and have in some cases) led to completely incorrect diagnoses and treatment decisions. Many of these errors were extreme misinterpretations and some appear to be outright lies, although part of me still can't fathom that a physician - someone who worked hard to get into a career around helping people - would ever outright lie.

While my psychiatrist only had irrelevant errors that don't bother me, I am angry that he essentially gaslit (I know the term is overused, but I can't think of another appropriate word) this whole time, working to make me believe that my suspicions were all in my head and rooted in psychosis, when they were not only real, but worse than I had ever guessed. I should mention that some of these significant errors were by providers from the same hospital and within the same "team" as he is in, where as others were from providers he has never been in contact with.

I can only hope and believe that my psychiatrist was working with good intentions, hoping that my consistent care under him was going to create a better trail of documentation over time that those other reports would be dismissed and that I would never even know about them.

So for this reason, and the reason of wanting some of my prescription options* to continue, I am not sure how to go about concluding my relationship with him and his practice at this time. As noted above, I feel my options are:

• Do I just "ghost" until I need a refill (2-4 months from now, depending on how I am doing), and at that time just reach out to the front desk and ask them to have the psychiatrist transfer Rx to my GP?
  
• Do I write a letter at this time to make the requested change, and if so, do I write an explanation as to why - my psychiatrist probably already has a general idea, although not specifics, as to why I would be making this decision
• Do I make an in-person appointment and provide the explanation/make the request? My only concern with this is that I would be taking a slot from someone who actually \wants* treatment, and that feels wrong to me.*

It is important to me that I fulfil whatever ethical obligation I have as a human being and as a patient in terms of providing an explanation for my step away from treatment - but I'm really not sure if there is any obligation. If this situation involved one of your patients, what would you expect versus what "explanation" would just be unnecessary?

*Two Rx would be of concern. One is a medication I am currently discontinuing, but based on my current state and trajectory, I may need to slow the discontinuation by a month or two. The other medication is one that I have been on for nearly a decade, including during hospitalizations, and it is a stimulant. My dose has remained the same for probably 9 of the ten years I have been on it (although I do frequently forget the afternoon dose much to the annoyance of my colleagues), and it has never had any negative side effects or triggered any negative mood states. I know stimulants are controversial, but it actually allowed me to decrease my medication load significantly with far more efficacy in return. My GP has no problem prescribing it because he knew me prior to being prescribed it, and has watched the significant improvement since, but still will only do so if my psychiatrist signs off on it.